scholarly journals The presence of symptons and symptom-rhythm correlation in patients with Implantable loop recorders

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
ML Goncalves ◽  
MARIA Goncalves ◽  
INÊS Pires ◽  
JOÃO Santos ◽  
JOANA Correia ◽  
...  
Keyword(s):  
Previous History ◽  
Heart Rhythm ◽  
Coronary Intervention ◽  
Ventricular Rate ◽  
Presenting Symptoms ◽  
Device Implantation ◽  
History Of ◽  
Implantable Loop Recorders ◽  
Diagnostic Outcome

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Implantable loop recorders (ILR) are a powerful diagnostic tool for heart rhythm diseases, and particularly useful when symptoms are infrequent or when long-term data are required. The main indication is for study of syncope/presyncope due to suspected cardioinhibitory etiology. OBJECTIVE To evaluate the diagnostic profitability of ILR in patient (P) with syncope/ presyncope and to evaluate the effect of symptons on follow-up. METHODS Included P undergoing ILR implantation in 6 consecutive years, to study syncope/presyncope. Information was collected on P characteristics, indication, diagnostic outcome and subsequent management and complications. A follow-up (FU) of 1 year and 3 years were done. Diagnostic outcome was based in symptom-rhythm correlation. Symptons and correlation to ECG during the FU and management after the diagnosis were assessed. RESULTS 99 P were selected. Evaluation of syncope in 91.9% (n = 91) and presyncope in 8.1% (n = 8). 54.5% female, median age 59.4 ± 17.4 years. 55.8% (n = 53) completed the 3 years FU and 84.2% (n = 80) completed the 1 year FU. Death occurred in 4% (n = 4) during the FU. ILR results led to device implantation in 35% of the P (22 pacemakers and 1 ICD) in 1 year FU, with a median time to implantation of 11.6 months after ILR, and the majority of ILR motivated by syncope (87%). If we consider only P that finished the 3 years of FU, in 47.2% P were implanted a device. The most common arrhythmic finding were AV block (47.8%), followed by sinus pauses / asystole (43.5%), AF with slow ventricular rate (4.3%) and VT (4.3%). 4.9% of P experienced a complication related to the device (2 infection and 3 non-infectious pain), that resulted in explantation. 60.9% of the P were symptomatic during the FU, with 24.1% achieving symptom-rhythm correlation and 36.8% who did not. Device implantation was associated with the presence of symptons in FU (82.6% vs 17.4%, p = 0.012) and symptom-rhythm correlation (95% vs 5%,p = 0.001). 38.7% (n = 27) of the P finished the 3 years of FU without a diagnostic outcome or detectable event, with 44.4% being assymptomatic and 55.6% presenting symptoms without ECG correlation. Compared to the P that implanted a device, this type of P was frequently of female sex (57.6% vs 30.4%, p = 0.045), younger age (54.8 ± 18.1 vs 65.8 ± 12.8 years, p = 0.014), with less cardiovascular risk factors like dyslipidemia (37.0% vs 78.3%, p = 0.003) and arterial hypertension (48.1% vs 73.9%, p = 0.05), AF (0% vs 19%, p = 0.025), previous history of myocardial infarction and percutaneous coronary intervention (3.2% vs 17.4%, p = 0.05; 3.0% vs 21.7%, p = 0.028) and more frequently with history of depression (51.9% vs 22.7%, p = 0.037). CONCLUSION In this study, ILR monitoring led to a device implantation in 47.2% of the P that finished the 3 years FU. The presence of symptons and symptom-rhythm correlation during FU was associated with device implantation.

scholarly journals Parenchymal mucinous cystadenoma of the kidney: a case report and literature review

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Mahmoudreza Kalantari ◽  
Shakiba Kalantari ◽  
Mahdi Mottaghi ◽  
Atena Aghaee ◽  
Salman Soltani ◽  
...  
Keyword(s):  
Renal Cyst ◽  
Left Kidney ◽  
Previous History ◽  
Mucinous Cystadenoma ◽  
Single Layer ◽  
Renal Cysts ◽  
Cystic Mass ◽  
Flank Pain ◽  
History Of

Abstract Background Mucinous cystadenoma (MC) of the kidney is exceedingly rare. We found 22 similar cases in the literature. These masses are underdiagnosed due to radiologic similarities with simple renal cysts. Case presentation A 66-year-old man with a previous history of hypertension and anxiety was referred to our tertiary clinic with left flank pain. Ultrasound revealed a 60 mm-sized, complex cystic mass with irregular septa in the lower pole of the left kidney (different from last year's sonographic findings of a simple benign cyst with delicate septa). CT scan showed the same results plus calcification. Due to suspected renal cell carcinoma, a radical nephrectomy was performed. Postoperative histopathologic examination revealed a cyst lined by a single layer of columnar mucin-producing cells with small foci of pseudo-stratification, consistent with the MC’s diagnosis. The first follow-up visit showed normal blood pressure without medication and no flank pain and anxiety after a month. Conclusion It is quite challenging to distinguish the primary MC of the kidney from a simple renal cyst based on clinical and imaging findings. The radiologic features of these entities overlap significantly. Thus, complex renal cyst and renal cysts with mural nodules should be followed closely to detect malignancy earlier.

scholarly journals An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events

2021 ◽  
Vol 11 (3) ◽  
pp. 178
Author(s):  
Noah R. Delapaz ◽  
William K. Hor ◽  
Michael Gilbert ◽  
Andrew D. La ◽  
Feiran Liang ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Previous History ◽  
Current Treatment ◽  
Careful Consideration ◽  
P Value ◽  
Post Traumatic Stress ◽  
Increased Risk ◽  
History Of ◽  
Almost All

Post-traumatic stress disorder (PTSD) is a prevalent mental disorder marked by psychological and behavioral changes. Currently, there is no consensus of preferred antipsychotics to be used for the treatment of PTSD. We aim to discover whether certain antipsychotics have decreased suicide risk in the PTSD population, as these patients may be at higher risk. A total of 38,807 patients were identified with a diagnosis of PTSD through the ICD9 or ICD10 codes from January 2004 to October 2019. An emulation of randomized clinical trials was conducted to compare the outcomes of suicide-related events (SREs) among PTSD patients who ever used one of eight individual antipsychotics after the diagnosis of PTSD. Exclusion criteria included patients with a history of SREs and a previous history of antipsychotic use within one year before enrollment. Eligible individuals were assigned to a treatment group according to the antipsychotic initiated and followed until stopping current treatment, switching to another same class of drugs, death, or loss to follow up. The primary outcome was to identify the frequency of SREs associated with each antipsychotic. SREs were defined as ideation, attempts, and death by suicide. Pooled logistic regression methods with the Firth option were conducted to compare two drugs for their outcomes using SAS version 9.4 (SAS Institute, Cary, NC, USA). The results were adjusted for baseline characteristics and post-baseline, time-varying confounders. A total of 5294 patients were eligible for enrollment with an average follow up of 7.86 months. A total of 157 SREs were recorded throughout this study. Lurasidone showed a statistically significant decrease in SREs when compared head to head to almost all the other antipsychotics: aripiprazole, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone (p < 0.0001 and false discovery rate-adjusted p value < 0.0004). In addition, olanzapine was associated with higher SREs than quetiapine and risperidone, and ziprasidone was associated with higher SREs than risperidone. The results of this study suggest that certain antipsychotics may put individuals within the PTSD population at an increased risk of SREs, and that careful consideration may need to be taken when prescribed.

Cardiac cephalalgia: severe, non-exertional headache presenting as unstable angina

2018 ◽  
Vol 19 (2) ◽  
pp. 173-175
Author(s):  
Jonathan Lazari ◽  
Andrew Money-Kyrle ◽  
Benjamin R Wakerley
Keyword(s):  
Clinical Characteristics ◽  
Troponin I ◽  
Coronary Intervention ◽  
Severe Stenosis ◽  
Exertional Headache ◽  
Percutaneous Coronary ◽  
History Of ◽  
St Elevation ◽  
Cardiac Cephalalgia

Cardiac cephalalgia is a migraine-like headache that occurs during episodes of myocardial ischaemia. Clinical characteristics of the headache vary widely but are often severe in intensity, worsen with reduced myocardial perfusion and resolve with reperfusion. It can present along with typical symptoms of angina pectoris, although not always. We present a 64-year-old man with a 6-month history of severe, non-exertional headaches occurring with increasing frequency. A resting ECG showed ST elevation in the inferior leads. His serum troponin I was not elevated. Coronary angiography showed severe stenosis of his right coronary artery, which was successfully stented by percutaneous coronary intervention. He remains headache free at 2-year follow-up.

scholarly journals Intracranial Hemorrhage Secondary to a Delayed Cerebral Pseudoaneurysm Rupture 18 Years after Cranial Trauma

2019 ◽  
Vol 11 (3) ◽  
pp. 325-329
Author(s):  
Mikel Terceño ◽  
Sebastià Remollo ◽  
Yolanda Silva ◽  
Saima Bashir ◽  
Carlos Castaño ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Previous History ◽  
Complete Recovery ◽  
Good Clinical Outcome ◽  
Intracranial Hematoma ◽  
Cranial Trauma ◽  
History Of ◽  
Etiological Study

We report the case of a 38-year-old male with a previous history of severe cranial trauma and subsequent large subdural and subarachnoid hemorrhage on whom an emergent hematoma evacuation was performed with a good outcome and follow-up. Despite a good clinical evolution, the patient experienced a further intracranial hematoma 18 years after the trauma, with severe aphasia and mild right hemiparesis. After complete etiological study, two cranial pseudoaneurysms were observed in the cerebral angiography. Endovascular treatment was successfully completed, achieving full embolization without complications. No rebleeding was detected during follow-up. The patient had a good clinical outcome at 3 months and achieved complete recovery. Cranial pseudoaneurysm rupture is a rare cause of intracerebral hemorrhage, especially if the trauma occurs years before the bleeding.

Suicidal Intent in Self-Injury

1977 ◽  
Vol 130 (4) ◽  
pp. 377-385 ◽  
Author(s):  
David W. Pierce
Keyword(s):  
Psychiatric Treatment ◽  
Previous History ◽  
Isolation Method ◽  
Suicidal Intent ◽  
Self Injury ◽  
Suicide Prediction ◽  
Long Term Follow Up ◽  
History Of

SummaryThe difficulties in measuring suicidal intent in cases of self-injury are discussed, and a scale is described to measure this intent. This scale has been used in 500 cases of self-injury. It is practical and reliable. Results show that the scores derived from it are closely related to the similar Beck Scale; they are also related to age, sex, social isolation, method of self-injury, previous history of self-injury or of psychiatric treatment, physical health at the time of self-injury and alcohol abuse. These results are discussed with particular reference to suicide prediction and the future validation of the scale by long-term follow-up.

Essential Thrombocythemia: Analysis of Risk Factors for Thrombotic Events in a Series of 306 Patients.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4937-4937
Author(s):  
Franca Radaelli ◽  
Stefania Bramanti ◽  
Mariangela Colombi ◽  
Alessandra Iurlo ◽  
Alberto Zanella
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Essential Thrombocythemia ◽  
Thrombotic Event ◽  
Previous History ◽  
Significant Difference ◽  
Platelet Number ◽  
History Of

Abstract Essential thrombocythemia (ET) is a chronic myeloproliferative disorder characterized by peripheral thrombocytosis and abnormal proliferation of megakariocytes in the bone marrow. Even thought thrombosis is frequently associated to ET, the risk factors of this clinical complication are still controversial. The aim of this retrospective, single institution study was to investigate clinical and laboratory characteristics associated with the occurrence of thrombotic events, with the purpose of identifying subgroups of patients who could benefit from antiaggregant and/or cytostatic treatment. 306 consecutive ET patients (109 men and 197 females, median age 58 yr) diagnosed between January 1979 and December 2002 were included in the study. At the time of analysis, 196 patients were still alive with a median follow up of 96 months. The following variables were investigated for the association with thrombotic complications: age, platelet count, previous history of thrombotic events, time from diagnosis, treatment with antiaggregant/cytostatic drugs, and cardiovascular risk factors such as arterial hypertension, obesity, hypercolesterolemia, diabetes, cigarette smoking. At the time of last follow up, 46 patients (15%) experienced at least one thrombotic event. The occurrence of thrombotic events was observed in 26/64 (40.6%) patients with previous history of thrombosis and in 20/242 (8.3%) patients with no previous history of thrombosis (p&lt;0.0001 Fisher’s exact test, odd ratio 7.6). A significant difference between the two groups of patients was also confirmed when Kaplan Meier estimates of thrombosis-free survival were compared by log-rank test (p&lt;0.0001). By logistic regression, platelet number at diagnosis did not associate with occurrence of thrombosis in the whole patient population. When patients without previous history of thrombosis were stratified according to the number of cardiovascular risk factors (none vs one vs more than one), a significant correlation with occurrence of thrombotic events was observed (Mantel-Haenszel Chi-square 5.47, p&lt;0.05). This study confirms that history of thrombosis is strongly related with risk of further thrombotic events in patients with ET, whereas platelet number at diagnosis does not seem to represent a prognostic factor. In patients with no previous history of thrombosis, the presence of other cardiovascular risk factors has to be taken into account when establishing the therapeutic approach.

Pleural Effusions Associated with Use of Dasatinib in Chronic Myeloid Leukemia May Have an Auto-Immune Pathogenesis.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2945-2945 ◽  
Author(s):  
Sinthiya Punnialingam ◽  
Hugues de Lavallade ◽  
Dragana Milojkovic ◽  
Bua Marco ◽  
Jamshid S. Khorashad ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Autoimmune Disease ◽  
Skin Rash ◽  
Previous History ◽  
Fluid Retention ◽  
Pleural Effusions ◽  
Imatinib Resistance ◽  
Immune Pathogenesis ◽  
History Of

Abstract Pleural effusions (PE) are a relatively common side effect of dasatinib (an oral multi-targeted kinase inhibitor) and have been reported in 20–30% of CML patients. The underlying mechanism is unclear but may be related to inhibition of the PDGFR gene. We report a series of 43 patients, who received dasatinib while in first chronic phase, after imatinib resistance (n=31) or intolerance (n=12). Twenty two patients had previously received interferon. Patients were treated with dasatinib 70 mg twice daily. The median follow-up was 149 days (range 21–730). Of the 43 patients, 14 developed PE at a median of 150 days (range 21–698) after starting dasatinib. The dasatinib was interrupted in all cases and not resumed until the PE had resolved completely, which occurred in all cases. Diuretics were administered in some cases. The median duration of discontinuation was 14 days (range 7–65). In 8 of the 14 patients the drug was re-started at reduced dose following the first episode of PE. PE recurred in 4 patients (3 patients had two and 1 patient 5 episodes). The dose was further reduced in these cases and eventually abandoned in 2 patients. We performed univariate and multivariate analysis to identify prognostic factors for the development of PE. Significant variables were: prior skin rash on imatinib therapy, [21% non PE vs 57% PE (p=0.035)], skin rash on dasatinib [(before the development of PE vs any time during the follow up) 4% non PE vs 47% PE (p=0.002)], and previous history of autoimmune disease, [non PE 7% vs 50% PE (p=0.006)]. The documented autoimmune diseases were: hyperthyroidism (n=1), hypothyroidism (n=3), systemic lupus erythematosus (n=1), Sweets syndrome (n=1) and auto-immune hepatitis (n=1). We did not find correlation between the previous history of autoimmune disorders and having been treated with interferon. The dose of dasatinib prior to the onset of PE was compared with the dose in patients who did not develop PE at 6 months; patients still receiving 70 mg twice a day were more likely to develop PE than those for whom the dose had been reduced, with a relative risk (RR) for the development of PE of 4.7 (95CI 1.2–18.4, p=0.02). The only variables that were predictive in the multivariate analysis were a history of autoimmune disease and the dose of dasatinib [RR 13 (95CI 1.6–103) and RR 7.4 (95CI 1.2–44.3) respectively]. Interestingly the presence of generalised fluid retention was not found to be significant (p=0.54) nor the previous therapy with interferon (p=1.0). Our results are in agreement with recent reports which suggest that dasatinib-induced PE does not correlate with generalised fluid retention and may be mediated by an immune mechanism. Moreover dasatinib-induced PE are usually exudates and are believed to respond to steroids. In summary in this series PE occurred more frequently in patients with a previous history of autoimmunity and imatinib-related dermatological side effects; both observations support the notion that PE secondary to dasatinib therapy may have an auto-immune pathogenesis.

Translocation (X;20)(q13;q13.3): Report of Three Additional Cases.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4264-4264
Author(s):  
Chandrika Sreekantaiah
Keyword(s):  
Bone Marrow ◽  
Myeloid Leukemia ◽  
Bone Marrow Aspiration ◽  
Unknown Etiology ◽  
Acute Monocytic Leukemia ◽  
Monocytic Leukemia ◽  
Presenting Symptoms ◽  
Recurrent Translocation ◽  
History Of

We report a recurrent translocation (X;20)(q13;q13.3) in three patients. The translocation was the sole chromosomal abnormality in all three patients and the number of cells with the abnormality varied from three to seventeen out of twenty metaphases analyzed for each patient. The patients were all female with ages ranging from 66 to 83. The presenting symptoms were variable but all included a history of anemia. Bone marrow aspiration showed acute monocytic leukemia in one patient and normocellular bone marrow with no detectable morphologic or immunophenotypic evidence of neoplasm in the other two. Only eight cases with the translocation have previously been reported. Seven of these cases had either myelodysplastic syndrome or acute myeloid leukemia and one patient had pancytopenia of unknown etiology. Repeated bone marrow evaluations on this patient showed no dyspoietic changes. The t(X;20) has clearly been established as a nonrandom abnormality, however, the clinical significance of the translocation is not clear. Close follow up of these patients is therefore essential. Characterization at the molecular level will also help to determine the genes involved and the mechanism of their action.

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